3
Estimating Age of Onset Clinical history Asking family members (considerable consistency, unclear validity) Review of old medical records Estimation of dementia severity Time-index back calculation to onset Functional brain scan severity analysis Back calculation to onset

4
Assessment History Of The Development Of The Dementia Ask the Patient What Problem Has Brought Him to See You Ask the Family, Companion about the Problem (necessary) Specifically Ask about Memory Problems Ask about the First Symptoms Enquire about Time of Onset Ask about Any Unusual Events Around the Time of Onset, e.g., stress, trauma, surgery Ask about Nature and Rate of Progression Ask about the current level of difficulties Review of old medical records Psychological Exam (MMSE) SPECT scan (ECD)

18
APOE AND EVOLUTION DOES APOE- e2 or e3 DO A SAFER JOB OF SUPPORTING THE REMODELLING OF DENDRITES, TO MINIMIZE THE STRESS ON THE NEURON OVER TIME? DEMENTED ELDERLY CAN NOT FOSTER THEIR YOUNG OR COMPETE APOE AS AN AGENT TO SUPPORT SUCCESSFUL AGING IN GRANDMOTHERS APOE AS AN AGENT TO SUPPORT THE DOMINANCE OF ELDERLY MALES

21
Implications of Genotype for Alzheimer diagnosis APOE genotype provides major information about an individuals risk of developing Alzheimer’s disease!! APOE genotype can strengthen or weaken diagnostic considerations, particularly in individuals with estimated age of onset less than 70 years of age. APOE genotype may influence the relevance of certain factors for prevention and treatment.

22
Are we ready to do genetic testing to predict AD? The family members want it They consider recommendations against genetic testing to be “paternalistic” Family members can make more powerful financial decisions based on this knowledge than the relevance of insurance companies implementing changes in actuarial calculations Those at risk can seek more frequent testing This is the best opportunity for early recognition Those at risk will be better advocates for research Specific preventive treatments can be developed for each genetic factor

23
CONCLUSION Non-familial AD is mainly caused by genetic factors. APOE-e4 accounts for at least 50% of AD. APOE genotype relative to e2 may explain more than 95% of AD cases. Several other genetic factors account for an additional proportion of AD. Environmental factors are likely to cause neural injury which leads to an unmasking and enhancement of AD symptoms, affecting the probability of developing and age of onset of AD.

24
BLT/Ashford Memory Test (to detect AD onset) New test to screen patients for Alzheimer’s disease using the World- Wide Web – based testing Test only takes 1-minute Test can be repeated often (quarterly) Any change over time can be detected Test is at: www.ibaglobal.com/BLTwww.ibaglobal.com/BLT For info, see: www.medafile.comwww.medafile.com

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